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Today I have the incredible joy of talking to the medical students on our rotation. No agenda, just a conversation that they requested for some “advice”. They just started their surgery rotation last week and it’s their first rotation. First rotation, beginner’s mind, unbridled enthusiasm… it is so wonderful!. I decided I would come up with what I wish someone had told me at the beginning of my rotations…

This is probably the most important piece of advice I can give. Clinical rotations are often a whirlwind of work and you can be swept away without realizing it. Residents can ignore you, people can be cranky, patients can be difficult… and in the midst of all this, you are expected to learn to be a doctor. You have to stay in charge of that mission, no matter what is happening around you.

Take a little time to reflect on why you are doing this and what kind of person/doctor you want to become. When times get tough (and they will) hold on to it. If it helps you, come up with a slogan to repeat, keep on a piece of paper in your wallet or on your wrist

Learn to keep a “beginner’s mind”. When I was a student on core medicine I had a senior resident that showed me what beginner’s mind looks like. It was 2am and I was tired. We were seeing a gentleman at the VA hospital for his diabetes, hypertension and some electrolyte abnormalities. I presented the patient to the resident and then we went to see him together. He had a rash, which I thought was so insignificant that I didn’t even include it in my presentation. But, instead of scolding me, this resident got excited. Yes, you read that correctly, 2am and excited about a rash – because he didn’t know what it was. (This next part will date me, but it’s a great example to make us grateful for the access we have to information now). He called security and had them open the library. We spent a wonderful hour looking through books – like a treasure hunt when we were little kids – until we found the rash in one of the books. We were laughing, excited and couldn’t wait to get back to start the appropriate therapy.

Understand what you are going to learn (the big picture)

On every rotation, you will be given a list of learning objectives. By all means, know them, study the things listed and make sure you know them (they will be on the test). BUT… please realize that diseases don’t stay conveniently siloed in a single specialty so this is not learning “surgery”, it’s learning about how surgeons approach a specific disease you will see elsewhere, too. You also need to know that what is listed as learning objectives today may well be obsolete tomorrow (if they aren’t already).

You have chosen a career that ethically demands life-long learning. That means that one of the most important skills to learn is how to develop a system of learning that you can use in medical school, residency and later in practice.

Learning is iterative. You will learn broad concepts on each rotation along with a “fly over” of the entire terrain of the specialty You will need the information you learn on your surgery rotation on your medicine rotation when you are consulted on a patient with an ischemic leg who needs surgical treatment, or on your pediatrics rotation when your patient with a pneumonia develops an empyema. If you choose surgery at your career, you will read and learn the same topics throughout your residency (and after) but with increasing depth.

Pay attention to ergonomics, diet, exercise and sleep. Most importantly, take care of yourself emotionally and spiritually. You can’t learn or serve others if your tank is empty. Come up with what is important for you and make a list. Seriously. Make a list of what you find helps you stay on track and then check it off every day. Look at it before you go to bed. Celebrate the things you did and don’t be hard on yourself for the ones you didn’t get to.

We have the most amazing job on earth. When the administrative issues or political conflicts get to you (and they will), just remember – you get to take care of another human life with the goal of relieving their suffering. What could be more important than that?

The following is taken from The Resilient Clinician by Robert J. Wicks. Dr. Wicks writes primarily for psychiatrists and other mental health workers, but his advice is applicable to anyone who works with patients.

There are basic elements of a self-care protocol that most everyone needs to renew themselves on an ongoing basis. It really doesn’t require too much to take a step back from our work routine to become refreshed and regain perspective. Some of the basic elements might include:

• Quiet walks by yourself

• Time and space for meditation

• Spiritual and recreational reading-including the diaries and biographies of others whom you admire

• Some light exercise

• Opportunities to laugh offered by movies, cheerful friends, etc.

• A hobby such as gardening

• Phone calls to family and friends who inspire and tease you

• Involvement in projects that renew

• Listening to music you enjoy (Wicks, 2003, p. 50)

Other simple steps at self-care and renewal might be:

• Visiting a park or hiking

• Having family or friends over for dinner or evening coffee

• Going to the library or a mega-bookstore to have coffee, a scone, and to peruse the magazines

• Shopping for little things that would be fun to have but not cost a lot

• Taking a bath rather than a quick shower

• Daydreaming

• Forming a “dining club” in which you go out once a month for lunch with a friend or sibling

• E-mailing friends

• Listening to a mystery book on tape

• Reading poetry out loud

• Staying in bed later than usual on a day off

• Having a leisurely discussion with your spouse over morning coffee in bed

• Watching an old movie

• Making love with your spouse

• Buying and reading a magazine you have never read before

• Fixing a small garden with bright, cheery flowers

• Telephoning someone you haven’t spoken to in ages

• Buying and playing a new CD by a singer or musician you love

• Taking a short walk (without listening to music) before and after work and/or during lunchtime

• Going to a diner and having a cup of tea and a piece of pie

• Going on a weekend retreat at a local spirituality center or a hotel on large grounds so you can take out time to walk, reflect, eat when you want, read as long as you’d like, or just renew yourself

• Arranging to spend a couple of days by yourself in your own home without family or friends present just to lounge around and be alone without a schedule or the needs or agendas of others

• Getting a cheap copybook and journaling each day as a way of unwinding

People who are ill or hurting often turn to their religious roots for solace. The mind and body connection is a powerful one, and one that can contribute to good patient care. Spirituality in medicine can take an overtly religious tone, but only if both the physician and patient are completely comfortable. No matter what your religious background, you will care for patients whose belief system is different from your own. The true root of spirituality in medicine is compassion. Regardless of your religious background and your personal beliefs you can cultivate a philosophy of compassion. Both you and the patients you care for will do better because of it.

The workday can be onerous and fatigue can make you lose perspective. It is important to find something greater than you and spend some time there everyday. The most efficient method is to look inside of yourself by just sitting. Learn to just sit. It is harder than it sounds, but very powerful when achieved. Slow your breathing, close your eyes and let the thoughts go. Concentrate on your breathing and relax all your muscles. Don’t fidget, don’t move. When the thoughts start running (and they will), just acknowledge them and let them go. Try to get to a moment (and that it all it will usually be) when your mind is silent and your body relaxed. This is the moment to listen. Being able to quiet yourself this way is very conducive to allowing your mind to work on the “big picture”. If you spend even 10 minutes everyday in this kind of meditation, you will be surprised at how some of the things that are worrying you become “solved”.

Work at finding beautiful places where you can sit for a minute or walk. Nature is one of the most powerful spiritual experiences. If you have a favorite place to hike or be outside, take some pictures and blow them up for your house or call room. Put beautiful plants in your house and then take care of them. (Dead plants are a bad way to cultivate spirtituality…) Watch for the surprising moments of beauty in a day and notice them. Look for the flower blooming outside a patient’s room, the proud look of a father watching his two-year-old totter into the hospital, a new painting on the wall.

Cultivate a sense of wonder. Have you ever seen anything more incredible than a beating heart in a surgeon’s hand? Allow yourself a moment to be amazed in the middle of the day. People have incredible resilience at times – notice it and appreciate it.